MedPAC Issues Annual Report to Congress

The Medicare Payment Advisory Commission has sent its mandatory annual report to Congress.

Included in the report are sections on:

  • Beneficiary enrollment in Medicare: eligibility notification, enrollment process, and Part B late enrollment penalties.
  • Restructuring Medicare Part D for the era of specialty drugs.
  • Medicare payment strategies to improve price competition and value for Part B drugs.
  • MedPAC’s mandated report to Congress on clinician payments.
  • Issues in Medicare beneficiaries’ access to primary care.
  • Assessment of the Medicare Shared Savings Program’s effect on Medicare spending.
  • Ensuring the accuracy and completeness of Medicare Advantage encounter data.
  • Redesigning the Medicare Advantage quality bonus program.
  • Payment issues in post-acute care.
  • MedPAC’s mandated report to Congress on changes in post-acute and hospice care after implementation of the long-term care hospital dual payment rate structure.
  • Options for slowing the growth of Medicare fee-for-service spending for emergency department services.
  • Promoting integration in dual-eligible special needs plans.

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

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Surprise! Teaching Hospitals Cost Less Than Non-Teaching Hospitals

30-day and episode-of-care costs are lower for care provided by major teaching hospitals than they are for other teaching hospitals and non-teaching hospitals.

Or so concludes a new study published by JAMA Open Network.

According to the study:

  • Major teaching hospitals’ initial hospitalization costs are higher.
  • Major teaching hospital costs are less than other hospitals after 30 days of care and over entire episodes of care.
  • Major teaching hospitals’ costs are similar to those of other teaching hospitals and non-teaching hospitals over a 90-day episode of care.
  • Major teaching hospitals’ patients incurred lower costs for post-acute care.
  • Major teaching hospitals have lower Medicare readmission rates.

Learn more about the study, how it was conducted, and what it found in the JAMA Open Network article “Comparison of Costs of Care for Medicare Patients Hospitalized in Teaching and Nonteaching Hospitals.”

CMS Seeks Help With Reducing Administrative and Regulatory Burdens

Reducing administrative and regulatory burdens is the subject of a new request for information issued last week by the Centers for Medicare & Medicaid Services.

In the RFI, CMS explains that it is especially interested in “…innovative ideas that broaden perspectives on potential solutions to relieve burden and ways to improve”

  • reporting and documentation requirements
  • coding and documentation requirements for Medicare or Medicaid payment
  • prior authorization procedures
  • policies and requirements for rural providers, clinicians, and beneficiaries
  • policies and requirements for dually enrolled (Medicare and Medicaid) beneficiaries
  • beneficiary enrollment and eligibility determination
  • CMS processes for issuing regulations and policies

Comments are due to CMS by August 12.

For further information, see the CMS news release “CMS Seeks Public Input on Patients over Paperwork Initiative to Further Reduce Administrative, Regulatory Burden to Lower Healthcare Costs” or go here to see the RFI itself.…

PACE Regulation Updated

PACE programs will have new flexibility under a recent update of regulations governing Programs of All-Inclusive Care.

As described by the National Association of Medicaid Directors, the new regulation

  • Allows PACE team members to fulfill multiple roles on the care team;
  • Allows certain non-physician providers to serve in the place of primary care physicians on the care team;
  • Clarifies that PACE programs offering prescription drug benefits are subject to Medicare Part D regulations;
  • Eliminates requirements for PACE organizations to seek waivers for several of the most commonly waived aspects of PACE regulation; and
  • Updates CMS’s enforcement actions to promote accountability in PACE.

PACE, as described in the CMS fact sheet announcing the regulation update,

… provides comprehensive medical and social services to certain frail, elderly individuals who qualify for nursing home care but, at the time of enrollment, can still live safely in the community. The majority of participants served by PACE are dually eligible for both Medicare and Medicaid. More than 45,000 older adults are currently enrolled in more than 100 PACE organizations in 31 states…

Learn more from the CMS fact sheet describing the updated regulation or go here to see the regulation itself.

ACA Tied to Reduced Disparities in Cancer Care

Improved access to health insurance has led to reduced racial disparities in the diagnosis and treatment of cancer.

As reported by the Washington Post,

According to researchers involved in the racial-disparity study, before the ACA went into effect, African Americans with advanced cancer were 4.8 percentage points less likely to start treatment for their disease within 30 days of being given a diagnosis.  But today, black adults in states that expanded Medicaid under the law have almost entirely caught up with white patients in getting timely treatment, researchers said.

Another study found that since the reform law’s implementation in Medicaid expansion states, women are being diagnosed and treated earlier for ovarian cancer than they were in the past.

Researchers also note that disparities, so often viewed from a racial and socio-demographic perspective, are now being seen on a geographic basis depending on whether individual states expanded their Medicaid program.  As one observer explained,

We are moving from black-white disparities to Massachusetts versus Mississippi disparities.

Learn more from the Washington Post article “ACA linked to reduced racial disparities, earlier diagnosis and treatment in cancer care.”